Laureen: Next is my question. Q: Please, could we do a review of behavioral health? I noticed the E/M and Psychotherapy coding algorithm that appeared in the 2104 CPT manual. Laureen asked me to mention it so that it could be gone over in the next Q&A session. A: Let me think, we had this actually for last month but we ran out of time. The one thing that I wanted to draw your attention to, you might not have noticed in the front of CPT for this year 2014, there’s this appendix XXII and it’s a reprint, and I’ve never seen CPT do this in my years of coding. They reprinted a CPT Assistant article about this topic, so apparently there’s a lot of confusion around that and they thought it would just be helpful just to reprint this and make it easy.
E and M Coding – Review of Behavioral Health – Video
Basically, what changed? These are in 2013, not 2014; but the article is in the front of the book and that’s what this writer was asking about. They used to divide the psych codes by outpatient and inpatient, and then further divided by all these different ways. Now, they just put them all into one category. It doesn’t matter if they’re inpatient or outpatient. As far as the timing goes they used to give you ranges, now they give you set numbers: 30 minutes, 45 minutes, 60 minutes. Here’s just a scan of my CPT manual with my notes on the psychotherapy codes. You can see the first grouping 90832 and 90833 is based on 30 minutes. The next grouping is the 834 grouping that’s 45 minutes, and 837 is 60 minutes. Just to show you the minutes now, not a range it’s an exact number. My note here is: The code is now selected based on the actual time closest to the time reference in CPT. And if it’s less than 16 minutes, then don’t code psychotherapy. The third change that we saw in 2013 is that: The single psychiatric diagnostic evaluation code has been replaced by two codes: one for a diagnostic evaluation and the other for a diagnostic evaluation with medical services. So, those are the big changes. If you look at the codes more closely, this is an additional change: when we’re dealing with 30 minutes, 90832, there’s now an add-on code if it’s with an E/M. But this is the trick, some people thought we were done there, you just coded the add-on code and that included the E/M. It actually tells you that we are to use that in conjunction with – look at the parenthetical notes, they’re your friend. 99201 to 99255, so those are regular E/M codes. So, we could actually have three codes, 90832, 90833 and then the regular E/M based on the HEM – the level of history, the level exam, the level of medical decision making. OK? That was the big change in the algorithm. So, get in your first bubble, if you will, or grouping based on time and then ask yourself was it done with an E/M or not; if so, do the add-on code and then figure out the regular E/M based on the level of history, exam, and medical decision making. OK? Then there’s one extra thing, is the use of this interactive complexity add-on code, 90785. You’ll see I wrote in my notes, it’s kids or language difficulties. Picture a stroke patient who’s lost the ability to speak: it’s going to be very hard to do psychotherapy for them if they can’t communicate back, how they’re feeling and everything. So, the interactive part is they’ll use other devices to help them communicate or maybe an interpreter or a third party or in the case of kids and toys or play objects. If that’s the case then you can go ahead and use this add-on code as well. You want to be careful though that this add-on code is not to be used when there’s the assessment or the diagnostic eval being done. This is to go with the psychotherapy or the treatment. It says right in there right from the guidelines: Code 90785 is an add-on code to report interactive complexity services when provided in conjunction with the psychotherapy codes, they give you the specific range. The amount of time spent by a physician or other qualified health care professional providing interactive complexity services should be reflected in the timed service code for psychotherapy. So that 30, 45, 60 minutes, or the psychotherapy add-on code performed with an E/M, and the other three add-on codes. That’s really it on that one, so hopefully that will help clarify that algorithm a little bit.
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